Provider Demographics
NPI:1083837421
Name:AFFILIATED FOOT CENTER, P.C.
Entity type:Organization
Organization Name:AFFILIATED FOOT CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:CARL
Authorized Official - Last Name:FOLLOWWILL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:817-491-4345
Mailing Address - Street 1:PO BOX 543151
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75354-3151
Mailing Address - Country:US
Mailing Address - Phone:817-491-4345
Mailing Address - Fax:214-350-2262
Practice Address - Street 1:2800 E HIGHWAY 114 STE 210
Practice Address - Street 2:
Practice Address - City:TROPHY CLUB
Practice Address - State:TX
Practice Address - Zip Code:76262-5307
Practice Address - Country:US
Practice Address - Phone:817-491-4345
Practice Address - Fax:214-350-2262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX314927001Medicaid
TX4603880001Medicare NSC